Laparoscopic heminephrectomy in infants and children: first 54 cases

ObjectiveHeminephrectomy in the pediatric population remains a popular open surgical procedure. We describe our experience with laparoscopic heminephrectomy using a retroperitoneoscopic approach.Materials and methodsData were collected retrospectively and prospectively on all patients undergoing laparoscopic heminephrectomy by a single surgeon using a prone retroperitoneoscopic approach. Information relating to the age, sex, laterality, duration of surgery, analgesic requirements, duration of hospital stay, postoperative complications and outcome was recorded.ResultsBetween March 2001 and August 2005 54 laparoscopic heminephrectomies were performed in 48 children (34 girls and 14 boys). The median age at surgery was 14 months (range 2–112 months). Forty-four upper and 10 lower moieties were removed. The median operative time was 105 min (range 50–150 min). There were no intraoperative complications and no conversions. There were four minor complications, comprising haematuria (n = 1) and postoperative pyrexia (n = 3). The median length of follow up was 22 months (range 3–57 months). All patients remained asymptomatic at last follow up. Ultrasound findings included presence of a visible ureteric stump (n = 7) and cysts at the resection margin of the remaining remnant (n = 17); none of these patients manifested clinical symptoms (e.g. infection, pain).ConclusionsWith advanced laparoscopic skills, laparoscopic heminephrectomy is a feasible operation for the treatment of non-functioning duplex renal units in children and infants.     

Relationship between body mass index and pediatric urologic diagnoses

ObjectiveWe had the clinical impression that children with certain urological diagnoses were thinner and others were heavier. We therefore reviewed body mass index (BMI) in children with a variety of urological diagnoses.Materials and methodsThe data from all pediatric patients treated as outpatients in our office between 1 Jan and 30 Sept 2004 were analyzed retrospectively. The patients were counted only once, even if they came back to the office several times. They were grouped by the principal billing diagnosis, but groups of less than nine patients were excluded. BMI percentiles were determined based on data from the Centers for Disease Control and compared to diagnosis codes.ResultsThe data from 1054 patients were analyzed: 53% were female, mean age was 8.0 ± 3.7, mean BMI was 18.7 ± 5.1 and mean BMI percentile was 64 ± 31%. BMI varied significantly by diagnosis. Children with hernias and penile problems had the lowest BMI percentile and those with urinary infection and incontinence the highest, e.g. the mean BMI percentile was 46 ± 31% for children with a hernia but 71 ± 27% for those patients with nocturnal enuresis.ConclusionsThe rate of obesity varied considerably based on pediatric urological diagnosis. Diet and personality may be part of the etiology for some urological disorders. It is possible that lifestyle changes may benefit urological patients who are obese.     

Percutaneous renal surgery in children with complex stones

ObjectiveWe report our experience with percutaneous nephrolithotomy (PNL) therapy for staghorn or complex pediatric renal calculi.Patients and methodsWe retrospectively analyzed the case records of 105 patients younger than 17 years who underwent PNL. The cases included 53 complex calculi analyzed in 51 patients. We defined complex calculi as either staghorn or those with a stone bulk larger than 300 mm², involving more than one calix, the upper ureter or stone in anomalous kidney.ResultsMean age of patients with complex calculi was 9.7 ± 0.7 years and stone burden was 654 ± 92.4 mm². The median duration of PNL was 90 ± 4.7 (30–220) min. Complete clearance was achieved in 39 patients (73.6%). Of these, 32 (60.4%) required a single tract, while 21 (39.6%) required multiple tracts. With subsequent shock wave lithotripsy and PNL, the clearance rate increased to 86.8%. The average hemoglobin drop was 1.6 ± 0.16 g/dL. Assessing the factors affecting the hemoglobin drop, the number of tracts (P = 0.01) and size of tracts (P = 0.002) were found to be significant. The mean change in serum creatinine concentration between preoperative and postoperative measurements was −0.01 ± 0.02 mg/dL, for both patients with a single tract and those with multiple tracts.ConclusionsPNL is safe and effective in the management of staghorn and complex renal calculi in children. Tract dilatation and number of tracts are important factors in reducing blood loss.     

Influence of type of conduit and site of implantation on the outcome of continent catheterizable channels

ObjectiveContinent catheterizable channels (CCC) using the Mitrofanoff principle are essential for pediatric urinary tract reconstruction. There is controversy over the influence of type of CCC (appendix vs. Yang–Monti) and site of implantation (augmentation vs. native bladder) on outcome.Patients and methodsA retrospective record review was conducted of all patients undergoing CCC since 1999, excluding patients who underwent seromuscular colocystoplasty. We analyzed the type of channel, site of implantation, complications requiring re-operation, and the revision rate according to type of CCC, type of stoma, site of implantation (bladder vs. augmentation) and segment used for augmentation (ileum vs. sigmoid colon).ResultsThere were 41 patients with a mean age of 11.2 years and a mean follow-up of 33.3 months. Of these, 33 CCC were constructed with appendix and eight with a Yang–Monti technique (4 ileal, 4 sigmoid); 31 patients also had an enterocystoplasty (19 sigmoid, 9 ileal and 3 others). Overall revision rate was 27%; revision was required in 8/33 (24%) appendiceal and 3/8 (38%) Yang–Monti CCC (P = 0.7). Revisions were required in 4/21 CCC implanted in the native bladder and 7/20 implanted in augmented bladder (P = 0.3). The majority of revisions were at skin level.ConclusionsAlthough there was no statistical difference in revision rate according to type of CCC, type of stoma or site of implantation, complications appeared to be more common in patients requiring a more complex reconstruction.     

Evaluation of cardiac arrhythmias by electrocardiographic markers in pediatric patients who have tuberous sclerosis without cardiac rhabdomyoma

BackgroundTuberous sclerosis (TS) is an autosomal dominant and hereditary disorder. Cardiac rhabdomyoma and arrhythmias are the most deleterious risk factors linked to TS. Although arrhythmias in pediatric patients with TS who have cardiac rhabdomyoma have been frequently reported, arrhythmia in patients who have TS without rhabdomyoma is rarely reported in the literature. The study aimed to assess the susceptibility of pediatric patients who have TS without cardiac rhabdomyoma to cardiac arrhythmia using electrocardiographic (ECG) markers.MethodsThis prospective study included 10 patients who had TS without cardiac rhabdomyoma. The control group was made up of 30 healthy children of the same age and sex as the patient group. P wave, P wave dispersion, QT dispersion, QTc dispersion, TP-e interval, and TP-e interval dispersion were calculated on 12-lead surface ECGs for each patient in both groups and compared.ResultsP wave, P wave dispersion, QT dispersion, and QTc dispersion were found to be significantly higher in the patient group (P < 0.001). Furthermore, patients had a greater Tp-e interval and Tp-e interval dispersion than healthy children (P < 0.001).ConclusionPediatric patients with TS without cardiac rhabdomyoma might be prone to atrial and ventricular arrhythmias according to their prolonged ECG markers. Our findings suggest that patients with TS without cardiac rhabdomyoma need close monitoring for atrial and ventricular arrhythmias.     

Clinical characteristics of patients with infection due to Influenza A (H1N1) 2009 and critical pathology

ObjectiveRetrospective, observational study in children hospitalized due to Influenza A (H1N1) between October 2009 and February 2010, emphasizing on those who required intensive therapy.Material and methodsRisk factors, symptoms, course, complications, mortality, time of disappearance of RT-PCR Influenza A (H1N1), average length of stay and duration of treatment with oseltamivir, were studied, comparing critically ill patients (group I) with the rest of hospitalized patients (group II).ResultsA total of 38 children, with a mean age of 5.03 ± 4.6 years were admitted during the study period. Six patients required intensive care, 83.3% had risk factors for influenza A (H1N1) compared with 62.5% in group II. Fever > 38 °C was the predominant symptom (92.1%). Respiratory symptoms were significantly more frequent in group I (83.3% vs. 33.6; P < .01). Two critically ill patients required mechanical ventilation due to ARDS (acute respiratory distress syndrome). One patient with exacerbation of chronic respiratory failure responded favourably to high-flow oxygen. One patient developed fulminant myocarditis and required ECMO (Extracorporeal Membrane Oxygenation) because of secondary cardiogenic shock, which developed into multiple organ dysfunction and brain death. Oseltamivir therapy was given for an average of 8.6 days in group I and 4.5 days in group II (P < .05), checking the negativity of RT-PCR Influenza A (H1N1) in 7 ± 2 days. The average stay was significantly higher in group I. Two patients admitted to PICU died.ConclusionsThe presence of risk factors increases the likelihood of unfavourable outcome: high mortality among patients requiring intensive care. Monitoring of RT-PCR Influenza A (H1N1) could help establish the duration of isolation measures.     

Childhood optic neuritis: The pediatric neurologist's perspective

BackgroundOptic neuritis in children may be an isolated, usually postinfectious event, or the symptom of a more widespread disorder.AimTo investigate the etiological spectrum of optic neuritis in children in association with diagnostic findings and follow-up results.MethodsWe retrospectively examined the records of 31 children aged 4–15 (mean 9.7 ± 2.9) years in whom isolated optic neuritis was the presenting neurological symptom.ResultsMonophasic bilateral optic neuritis was the most common presentation (45%), followed by the unilateral (32%) and recurrent (22%) forms. Initial cranial MRI was abnormal in 12/31 patients. During a mean follow-up of 2.2 years (6 months–15 years), 6/14 bilateral cases, 9/10 unilateral and 5/7 recurrent cases were diagnosed with various disorders including total eight with MS. The MS group tended to start with unilateral optic neuritis, was older (mean 11.6 ± 1.5 vs. 8.8 ± 2.9 years), and included more girls than the other groups.ConclusionsOptic neuritis in children is frequently part of a systemic or neurological disorder even in the presence of normal cranial imaging. These patients should be evaluated and followed-up in pediatric neurology clinics.     

Diagnostic accuracy of color Doppler sonographic study of the ureteric jets in evaluation of hydronephrosis

ObjectiveHydronephrosis (HN) and obstruction are closely associated, but upper urinary tract dilatation can occur without significant obstruction. Despite some pitfalls, conventional ultrasonography and diuretic renography (DR) are the main means of evaluation of HN in children. Recent reports have demonstrated color Doppler ultrasonography (CDUS) to reliably identify ureteric jets in the bladder. The aim of this study was to evaluate this method as a diagnostic tool to distinguish obstructive from non-obstructive dilatations of the upper tract.MethodsWe evaluated 51 patients (37 boys and 14 girls), aged 3 months to 14 years (median 4 years), who presented with unilateral grade III and IV hydronephrosis with suspicion of pyeloureteral junction obstruction. All patients underwent DR and evaluation of ureteric jets by transverse CDSG of the bladder within a maximum of 2 weeks. Obstruction was considered in the DR when the hydronephrotic unit showed a differential renal function of less than 40%, or when symptomatic intermittent renal colic was present in older children. The number of ureteric jets was counted over a 5-min period and the frequency calculated for each ureteral orifice. Relative jet frequency (RJF) was defined as frequency of the hydronephrotic side divided by total ureteric jet frequency. Receiver-operating characteristic (ROC) plots were constructed to determine the best cut-off for RJF, in order to identify renal units with obstructive hydronephrosis.ResultsTwenty-three (45.1%) hydronephrotic units were considered obstructed. The mean RJF differed between obstructive (0.09 ± 0.15) and non-obstructive hydronephrosis (0.42 ± 0.11) (p < 0.001). ROC analysis revealed that RJF <0.25 was the best threshold, and correctly discriminated obstruction in 91.2% of the children with a sensitivity of 87% (95% CI 78.6–98.2%) and specificity of 96.4% (95% CI 87.8–99%). The positive likelihood ratio was 24.3 and the area under the ROC curve was 0.92 (95% CI 0.86–0.98).ConclusionsRJF <25% was found to be a good indicator of obstruction in children with unilateral hydronephrosis. CDUS evaluation of ureteric jets is an easy and non-invasive method that can be used as an initial diagnostic tool, and in follow-up cases, to differentiate obstructed from non-obstructed hydronephrosis in the pediatric population.     

Angiotensin-converting enzyme gene polymorphism in North-west Indian children with posterior urethral valves

PurposeTo investigate the association of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and other risk factors with renal scarring in patients with posterior urethral valves (PUV).Materials and methodsForty consecutive patients from North-west India were treated for PUV in 1997–2004. The patients were divided into group 1 (no renal scarring, n = 12) and group 2 (renal scars present, n = 28) based on dimercato-succinic acid scans. ACE I/D polymorphism was determined by polymerase chain reaction in PUV patients and unrelated healthy controls (n = 100).ResultsMean age at presentation was 23.7 ± 37.2 months and mean follow up was 4.8 ± 1.5 years. Preoperative mean serum creatinine levels for group 1 (non-scarred) and group 2 (scarred) were 1.1 ± 1.6 mg/dl and 1.7 ± 1.6 mg/dl, respectively. One year after treatment, the serum creatinine levels had decreased to 0.6 ± 0.1 mg/dl and 0.8 ± 0.3 mg/dl in group 1 and group 2, respectively. ACE genotype distribution in children with PUV was no different from that of controls. The occurrence of D allele was significantly (p = 0.04) higher in patients of group 2. Multivariate logistic regression analysis showed that D allele had a significant impact on renal scar formation, introducing a 4.6-fold risk (odds ratio 4.6, 95% confidence interval 1.03–20.38, p = 0.04). A highly significant correlation between the occurrence of renal scarring and presence of breakthrough urinary tract infection (odds ratio = 7.5, 95% confidence interval 1.60–35.07, p = 0.006) and serum creatinine at follow up (odds ratio = 0.6, 95% confidence interval 0.47–0.81, p = 0.03) was observed. The mean values for glomerular filtration rate (GFR) after 1 year of treatment (p = 0.006) and at follow up (p = 0.027) were significantly different between the patients with II genotype and ID/DD genotype. Hypertension was observed in 13 patients and proteinuria in nine patients with no significant difference between the patients having II/I D/DD genotypes.ConclusionThe presence of D allele is associated with progression of renal scarring and reduced GFR in PUV patients.     

Modern staged repair of bladder exstrophy: a contemporary series

ObjectiveMany changes have occurred in the treatment of bladder exstrophy over the last few years and many repairs are now offered. The purpose of this study was to evaluate long-term outcomes in a select group of patients in whom modern staged repair (MSRE) was undertaken.Patients and methodsFrom an institutionally approved database were extracted 189 patients who had undergone primary closure between 1988 and 2004. The records of 131 patients (95 males) who underwent MSRE with a modified Cantwell-Ransley repair by a single surgeon in 1988–2004 were reviewed with a minimum 5-year follow up.ResultsSixty-seven patients with a mean age of 2 months (range 6 h to 4 months) underwent primary closure, and 18 underwent osteotomy at the same time. Mean age at epispadias repair was 18 months (8–24). Mean age at bladder neck reconstruction (BNR) was 4.8 years (40–60 months) with a mean capacity of 98 cc (75–185). Analysis of bladder capacity prior to BNR revealed that patients with a mean capacity greater than 85 cc median had better outcomes. Seventy percent (n = 47) are continent day and night and voiding per urethra without augmentation or intermittent catheterization. Social continence defined as dry for more than 3 h during the day was found in 10% (n = 7). Six patients required continent diversion after failed BNR. Seven patients are completely incontinent. The mean time to daytime continence was 14 months (4–23) and the mean time to night-time continence was 23 months (11–34). No correlation was found between age at BNR and continence.ConclusionsPatients with a good bladder template who develop sufficient bladder capacity after successful primary closure and epispadias repair can achieve acceptable continence without bladder augmentation and intermittent catheterization.     

Comparative efficacy and safety of extended-release and instant-release tolterodine in children with neural tube defects having cystometric abnormalities

AimTo evaluate the comparative efficacy and safety of extended-release (ER) and instant-release (IR) tolterodine preparations in a pediatric population with neural tube defects having cystometric abnormalities.Materials and methodsTwenty-five patients with neural tube defects and a similar demographic profile underwent a routine hemogram, liver function tests, renal function tests, urine culture, X-ray lumbo-sacral spine, and renal and bladder ultrasound. Vesicoureteric reflux was diagnosed by micturating cystourethrogram under fluoroscopy. Dimercaptosuccinic acid renal scintigraphy was performed to study the presence or absence of renal scars. Patients were treated with tolterodine ER (Group I: 2 mg once daily for 21 days) and tolterodine IR (Group II: 2 mg twice daily for 21 day) in a cross-over study with a 10-day washout period between administrations. Evaluation was by subjective assessment, visual analog scale, urodynamic assessment and adverse drug reaction monitoring.ResultsThere was ultrasound evidence of hydroureteronephrosis in 20% of the patients. One patient out of 25 had impaired renal function and eight patients had renal scarring on dimercaptosuccinic acid scans. Both forms of the drug increased the maximum cystometric bladder capacity, decreased detrusor leak pressures and increased compliance compared to pre-therapy levels (P = 0.0001). Visual analog scale showed a significant clinical improvement with both ER and IR tolterodine. A significant increase in maximum bladder capacity in the group receiving IR tolterodine as compared to the ER preparation was noted (P = 0.0001). The decrease in detrusor leak pressures and improvement in compliance were not significantly different between the groups. No adverse effects of hyperpyrexia, flushing or intolerance to outdoor temperatures, or dryness of mouth were observed in either group. No patient suffered from constipation.ConclusionER tolterodine 2 mg once daily is as effective and well tolerated in children with neurogenic bladder as IR tolterodine 2 mg twice a day. The latter was found to be more effective in terms of urodynamic parameters. ER formulation of tolterodine is less expensive and has the advantage of single dosage.     

Epidemiological study of type 1 diabetes in children under 15 years-old in Castilla-La Mancha (Spain)

IntroductionWe studied the incidence and prevalence of type 1 diabetes in children under 15 years-old in Castilla-La Mancha.Patients and methodsIncidence: All new cases in a 12 months period (2007-2008) were included. To calculate the completeness of ascertainment we used the capture-recapture method. The result is expressed in cases/100,000 inhabitants under 15 years old/year. Prevalence: all children under 15 years diagnosed with diabetes on 31^st of May of 2008 were registered. Results are expressed as cases/1000 inhabitants under 15 years old.ResultsThe incidence in the Castilla-La Mancha was 27.6/100,000/year, but there was a wide variability among the different provinces: Ciudad Real (34.15), Albacete (28.19), Toledo (26.57), Guadalajara (20.3) and Cuenca (17.6).The prevalence was 1.44/1000 children under 15 years old and 0.21/1000 for the whole population. By provinces: Ciudad Real (1.67), Albacete (1.64), Toledo (1.42), Cuenca (1.02) and Guadalajara (1.01).By sex and age, we found a higher incidence (13/7) and prevalence (22/7) in males under 5 years old. The age group with highest incidence was the 4-9 year-olds, and the highest prevalence was in the 10-14 years group.ConclusionsBoth, incidence and prevalence of type 1 diabetes in children under 15 years old in Castilla-La Mancha are high, with a wide range among the different provinces. There is a preponderance in males under 5 years old. The highest prevalence is that of the 10-14 years age group. The highest incidence was in the 5-10 year age group.     

The role of laparoscopic surgery for urinary tract reconstruction in infants weighing less than 10 kg: a comparison with open surgery

PurposeTo compare the outcome of laparoscopic urinary tract reconstruction (LUTR) in children weighing 10 kg or less with a weight-matched cohort undergoing open urinary tract reconstruction surgery (OUTR).Materials and methodsWe conducted a retrospective chart review of patients weighing 10 kg or less at the time of surgery who underwent open or laparoscopic pyeloplasty, transuretero-ureterostomy and ipsilateral uretero-ureterostomy between January 2000 and May 2007. The following information was recorded: body weight, age, sex, diagnosis, type of procedure, operative time, estimated blood loss, pre- and postoperative hemoglobin levels, length of hospitalization, length of follow up, use of drains and stents, intraoperative and postoperative analgesic requirement, need for readmission, subsequent procedures, costs, complications and reoperations.ResultsThere were 52 patients divided into two groups: LUTR (n = 23) and OUTR (n = 29). Median weight (range) and follow up was 6.2 kg (3.9–10) and 9 months and 6.5 kg (4.7–9.6) and 31 months for LUTR and OUTR, respectively. Mean operative time for LUTR (including cystoscopy and stent placement) was 237 min and for OUTR 128 min (P < 0.01). There were no differences in blood loss, intra- or postoperative analgesic requirement, results or complications. Mean hospitalization time was shorter for LUTR than OUTR (2 and 3 days, respectively). There were no differences in hospital costs between the two groups.ConclusionsLaparoscopic reconstructive surgery for congenital urological anomalies is safe and effective in small infants and can be performed with outcomes comparable to that of open surgery.     

Valor pronóstico de la espectroscopia cercana al infrarrojo en la encefalopatía hipóxico-isquémica

IntroductionDespite treatment with hypothermia, 40% of newborns with hypoxic-ischaemic encephalopathy die or suffer moderate to severe disability. Near-infrared spectroscopy (NIRS) could be a useful, non-invasive tool to establish the prognosis.ObjectivesTo evaluate the prognostic value of NIRS in predicting neurodevelopmental outcomes at 18 to 36 months in newborns with hypoxic-ischaemic encephalopathy, and to establish the time points and cut-off values of regional cerebral oxygen saturation that exhibit the strongest correlation to these outcomes.Patients and methodsThe study included all term newborns with hypoxic-ischaemic encephalopathy managed with hypothermia and NIRS between 2013 and 2016. We established 3 outcome categories: normal neurodevelopment, moderate disability and severe disability.ResultsThe sample comprised 28 newborns (median gestational age, 39 weeks; median birth weight, 3195 g). The median regional cerebral oxygen saturation increased from 65% to 85% at 48 hours post birth. Neurodevelopmental outcomes were normal in 28.6%, while 35.7% developed moderate disability and 35.7% severe disability; 3 patients died. We found a statistically significant difference between groups at 48 hours (P = .005) and after hypothermia (P = .03), with higher values in patients with disability. When we compared patients in the severe disability group with the other groups, we found a statistically significant area under the ROC curve at 48 hours of 0.872 (P = .001) applying a regional cerebral oxygen saturation cutoff of 83.5%. After hypothermia, regional cerebral oxygen saturation values below 66.0% (AUC, 0.794; P = .017) predicted normal development, while values above 82% (AUC, 0.881; P = .001) predicted severe disability.ConclusionsNIRS seems to be a valuable tool to predict neurodevelopmental outcomes in patients with hypoxic-ischaemic encephalopathy, even after hypothermia, with higher cerebral oxygen saturation values in patients with disability.     

Total endoscopic management (TEM approach) of children with non-compliant neuropathic bladder: a preliminary report

PurposeWe prospectively evaluated the efficacy and durability of a combination of intradetrusor botulinum-A toxin (BTX-A) and endoscopic treatment of vesicoureteric reflux (VUR) to manage children with myelomeningocele (MMC) and non-compliant refluxing bladders who were not responding to standard conservative therapy. We also evaluated whether this combined therapy can lower intravesical pressure, increase bladder capacity, gain social continence and protect the upper tract from recurrent urinary tract infection.Material and methodsA total of 10 patients with a mean age of 5.9 ± 3.6 years (range 2–12 years) with MMC (eight females and two males) were prospectively involved in the study. All patients were fully compliant to clean intermittent catheterization, and all were non-responders (failed to gain continence and/or poor compliance) to the maximum tolerable dose of anticholinergics and catheterization. All patients were subjected to cystoscopic intradetrusor injection of 12 U/kg (maximum 300 U) of BTX-A in an infection-free bladder. They all had VUR (16 refluxing ureters, six patients with bilateral VUR) and did not show resolution in the pretreatment voiding cystourethrogram; accordingly, submucosal injection of Deflux^® was performed either with the second BTX-A treatment (initial four patients) or with the first BTX-A treatment (the other six patients). The grade of reflux was G III, IV and V in three, seven and six ureters, respectively.ResultsThe maximum bladder capacity increased significantly from 79 ± 49 to 155 ± 57 ml (p < 0.022), and the maximum detrusor pressure decreased significantly from 55 ± 16 to 37 ± 11 cm H₂O (p < 0.001). Fifteen out of 16 (93.75%) refluxing ureters were completely resolved (one of them on second attempt), and one (6.25%) (GV reflux) remained unchanged despite of two attempts. Of six incontinent patients, five reached complete dryness between catheterizations and one showed partial improvement.ConclusionsA combination of BTX-A and endoscopic correction of VUR is a simple and effective way to overcome the increased risk of high intravesical pressure and recurrent UTI. This treatment decreases the incidence of renal damage in children on whom conservative management fails to help, in a minimally invasive way.     

Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia

IntroductionAdverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age.Patients and methodsA longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital “12 de Octubre” between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate.ResultsBoth motor skills were acquired later in the group with BPD (7.8 ± 2m vs. 7.1 ± 1.3m for sitting unsupported and 14.5 ± 3.8m vs. 13.4 ± 2.5m for walking) (P < .001). BPD was associated with delayed acquisition (above p90) of these skills, OR = 2.6 (1.6-4.1) for sitting and OR = 2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight.ConclusiónBPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.     

The appendix as ureteral substitute: a report of 10 cases

BackgroundUreteric replacement in part or in total is rarely needed in children. We present our experience in using the appendix to replace the ureter.MethodsA retrospective case note review was carried out at Sheffield Children's Hospital (UK), Ekta Institute of Child Health (Raipur, Chhattisgarh, India) and Christian Medical College Hospital (Vellore, India) of all cases of ureteric substitution using the appendix.ResultsTen patients were identified, operated in 2002–2007: seven males and three females with a median age of 2.5 years (range 2.5 months to 12 years). The reasons for ureteric replacement were traumatic ureteric avulsion (n = 1), congenital ureteric stenosis (n = 5), non-drainage following previous pyeloplasty for pelvi-ureteric junction obstruction (n = 3) and ureteric stricture following reimplantation for vesico-ureteric reflux (n = 1). The appendix was used in an anti-peristaltic manner in all cases, and in one case a transureteroureterostomy was performed. At a median follow up of 16 months (1–72 months), all the patients were well except one whose kidney function had deteriorated.ConclusionsTotal or partial replacement of the ureter using the appendix, even in the first year of life, preserved renal function in nine cases. Ureteric continuity can be successfully restored in children using the appendix.     

Are urodynamic studies really needed during bladder augmentation follow-up?

ObjectiveWe assessed clinical and urodynamic outcomes, over a minimum 10-year follow-up period, of neuropathic bladder patients treated with a bladder augmentation (BA) to determine if periodic urodynamic studies are needed.Material and methodsThirty-two patients with poorly compliant bladders underwent BA at a mean age of 11 years (2.5–18). Mean follow-up was 12 years (10–14.5) and mean patient age at the end of the study was 22 years (12.2–33). During follow-up all patients were controlled at regular intervals with urinary tract imaging, serum electrolyte and creatinine levels, cystoscopy and urodynamic studies. Preoperative, 1-year post-BA and latest urodynamic studies results were compared.ResultsUrodynamic studies at 1-year post-BA showed a significant increase in bladder capacity and a decrease in end-filling detrusor pressure compared with preoperative values (396 vs 106 ml; 10 vs 50 cm H₂O, P < 0.0001). The increase in bladder capacity was more significant at the end of the study than after 1 year (507.8 vs 396 ml, P < 0.002). Thirteen patients had phasic contractions after 1 year and 11 at the end (not significant, NS), and these contractions were more frequent with colon than with ileum (NS). At the end of follow-up, phasic contraction pressure had decreased while trigger volume had increased (35 vs 28 cm H₂O; 247 vs 353 ml, NS). All patients are dry and have normal renal function, except one who had mild renal insufficiency before BA.ConclusionBA improves bladder capacity and pressure, and these changes are maintained over time (although phasic contractions do not disappear). Repeated urodynamic studies are only necessary when upper urinary tract dilatation or incontinence does not improve.